Obstetric Anal Sphincter Injury
Conditions
Keywords
pelvic floor muscle exercises
Brief summary
Currently, guidelines from the Royal College of Obstetricians and Gynaecologists stipulate that all women who have sustained an obstetric anal sphincter injury in a previous pregnancy and who are symptomatic or have abnormal endoanal ultrasonography and/ or manometry should be counselled regarding the option of an elective Caesarean section. An abnormal endoanal ultrasonography is currently considered to be a defect of the external anal sphincter (EAS) of more than 30 degrees while an abnormal anorectal manometry would be an incremental squeeze pressure of less than 20mmHg. This study aims to evaluate if a course of guided pelvic floor exercises could improve anal sphincter function on those with suboptimal or abnormal anal incremental squeeze pressures, and subsequently expand their options for future modes of delivery (vaginal delivery not contraindicated)
Interventions
BEHAVIORALSupervised pelvic floor muscle exercises
4 months of supervised physiotherapy by a women's health physiotherapists (3 sessions in total)
Sponsors
King's College Hospital NHS Trust
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Female patients who have sustained an obstetric anal sphincter injury after their most recent delivery and: 1. Are at least 6 weeks postpartum 2. Has not received any form of guided pelvic floor exercises by a licensed women's health physiotherapist postpartum 2. Either able to speak, read and write in English, or has a professional interpreter present at the time of appointment. 3. Capable of understanding and signing the informed consent form after full discussion of the investigations and its risks and benefits. 4. Able and willing to complete the St Mark's Score, ICIQ-UI SF and other trial related questionnaires, comply with scheduled clinic visits and manometry studies.
Exclusion criteria
* Inclusion Criteria 1. Female patients who have sustained an obstetric anal sphincter injury after their most recent delivery and: 1. Are at least 6 weeks postpartum 2. Has not received any form of guided pelvic floor exercises by a licensed women's health physiotherapist postpartum 2. Either able to speak, read and write in English, or has a professional interpreter present at the time of appointment. 3. Capable of understanding and signing the informed consent form after full discussion of the investigations and its risks and benefits. 4. Able and willing to complete the St Mark's Score, ICIQ-UI SF and other trial related questionnaires, comply with scheduled clinic visits and manometry studies.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success | 4 months | 1. Change of incremental squeeze pressure from abnormal (\<20mmHg) or suboptimal (20-40mmHg) to normal (\>40mmHg) 2. Change of incremental squeeze pressure from abnormal (\<20mmHg) to suboptimal (20-40mmHg) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change or recommended mode of delivery | 4 months | Change of recommended mode of delivery from elective Caesarean section only to spontaneous vaginal delivery or elective Caesarean section |
| Change in St Mark's Score | 4 months | Change in St Mark's score before and after intervention |
| Change in International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) | 4 months | Change in ICIQ-UI SF before and after intervention |
| Change in Faecal Incontinence Quality of life Scale | 4 months | Change in Faecal Incontinence Quality of life Scale before and after intervention |
Countries
United Kingdom
Contacts
Primary ContactKar Yee Lor, MBChB
Outcome results
None listed